Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis Treatment strategies for OA pain should be broadened beyond a simple focus on the affected joint(s). While joint directed treatments remain sensible, it is important to screen for, recognize, and appropriately manage other factors (e.g., central sensitization, psychosocial factors, sleep problems) that may be contributing to an individual’s pain experience. Rehabilitation is considered first line treatment for OA pain. Core interventions that are widely recommended by evidence-based OA treatment guidelines include regular aerobic and resistance exercise, self-management programs, and, where appropriate, weight loss. A range of other options, such as manual therapy, thermal modalities, TENS, and joint braces/splints, may also be useful adjunct therapies, although there is currently less evidence supporting their use. CBT is increasingly recognized as a valuable treatment option for selected individuals and may have important clinical benefits for psychological and sleep related comorbidities. While further evidence is needed to support their clinical utility, novel treatment approaches, such as pain neuroscience education, the use of disinhibitory interventions to augment resistance training, blood flow restriction training, and brain directed treatments (e.g., illusory resizing and non-invasive brain stimulation) may play an important role in the future rehabilitation of OA pain. In addition, key avenues for future research include the development of personalized rehabilitation interventions and improved methods to both enhance treatment adherence and better understand its physiological underpinnings.
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